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Case Reports
. 2024 Jun 2;16(6):e61520.
doi: 10.7759/cureus.61520. eCollection 2024 Jun.

Life-Threatening Bleeding Following a Stable Fracture of the Superior Pubic Ramus: A Case Report

Zeinab Al-Rawi  1 , Yasmin Nached  1 , Abdulla Abdelwahab  1 , Baher M Samy  2
Affiliations
Case Reports

Life-Threatening Bleeding Following a Stable Fracture of the Superior Pubic Ramus: A Case Report

Zeinab Al-Rawi et al. Cureus. .

Abstract

Corona mortis, an anatomical variant documented in the literature, presents a noteworthy concern due to its proximity to the superior pubic ramus. Consequently, it remains susceptible to injury, even in stable, benign fractures of the pelvis, typically addressed through conservative management. Stable pelvic fractures are infrequently associated with complications; therefore, diligent monitoring is often overlooked in clinical practice. However, it becomes crucial, particularly in the elderly population given their suboptimal hemostatic capabilities. The standard approach for managing bleeding associated with pelvic fractures involves superselective embolization, a minimally invasive procedure with favorable outcomes. We present a case involving a 61-year-old female who experienced a stable pelvic fracture following low-energy trauma. Despite the ostensibly benign nature of the fracture, the patient exhibited hemodynamic instability attributable to bleeding from the corona mortis, necessitating embolization. The pelvic fracture itself was managed conservatively, leading to the patient's subsequent discharge in a stable condition. Therefore, we advocate for a comprehensive physical examination, serial hemoglobin monitoring, and additional imaging modalities based on the patient's clinical condition.

Keywords: arterial embolization; conservative treatment; corona mortis; low-energy pelvic trauma; stable pelvic fracture.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. X-ray of the pelvis, showing a fracture of the left sacral ala, right SPR, left SPR, and inferior pubic rami (blue arrows)
SPR: superior pubic ramus; AP: anteroposterior
Figure 2
Figure 2. CT of the abdomen and pelvis with contrast showing a substantial pelvic hematoma in the coronal and sagittal views (A,B), while in the transverse sections (C,D), the presence of contrast extravasation within the hematoma unequivocally indicates an ongoing active hemorrhage (arrows)
CT: computed tomography
Figure 3
Figure 3. Angiography showing an active extravasation at the right corona mortis (arrow)
Figure 4
Figure 4. A follow-up angiography demonstrating no further bleeding after embolization of the corona mortis
Figure 5
Figure 5. A CT of the abdomen and pelvis with contrast exhibiting an absence of delayed contrast extravasation in the pelvic hematoma
CT: computed tomography
Figure 6
Figure 6. Pelvic X-ray displaying the initial fractures in the healing process with a well-healed left IPR fracture with callus formation and a misaligned right SPR. Additionally, linear density can be seen projected on the right side of the pelvis, likely postembolization
IPR: inferior pubic rami; SPR: superior pubic ramus
Figure 7
Figure 7. An illustration of the corona mortis as described in our patient (created in iArtbook)
See this image and copyright information in PMC

References

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